Expert Canine New Client Information Form
Street Address Line 2
State / Province
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Mobile Phone Number
Other Phone Number
Emergency Contact Name & Phone #
Names & ages of other people in the dog's home
Dog's Name, gender, age, birthday, & breed
Dog's Color/ Markings and weight/size
When did the dog join you?
Is the dog sterilized?
If sterilized, when & by which vet?
Any other dogs in the home? If so, please state age, gender, breed, sterilization, and vaccination status.
What if any foods or other items is the dog allergic to?
What kind and quantity of food does your dog eat for meals, and how often?
How often does your dog get treats, and what kind?
Have there been any recent changes in health or any recent injuries?
When was the dog's last vet visit, and for what?
When was the dog's last rabies vaccination, and by what vet? 3 year or 1 year vaccine?
Name & ph# of vet
When were the dog's last parvo & distemper vaccinations (and any others)?
What medications is the dog on currently and/or what medications has the dog had within the six months or so?
Has the dog ever been prescribed (whether taken or not) psychoactive medication? If so, which meds and for what conditions?
Have psychoactive medications ever been suggested or requested for your dog by you or by anyone else? If so, what was the response?
Has the dog had any surgeries, illnesses, or other treatments in the past year or two?
Do you give permission for your dog's veterinarians to provide vet records and notes to us?
Please provide all of dog's vets' names and contact info.
If you answered no to the above, please provide us with a copy of current vaccination records and give your vets permission to confirm them with us via telephone.
Enter vet's name & telephone number above.
Where did you obtain this dog?
Friend or Family
Craigslist, Facebook, newspaper, or other ad
I found the dog (lost dog/stray/wandering)
This dog is from a litter of another dog of mine.
Did the dog live with other owners, fosters, or anyone else before you? Please give all details possible.
Do you know what, if any, type of training (or handling) others used with the dog before you obtained the dog? Please provide details if known.
What types of handling & training methods & equipment have you used with the dog? Please elaborate in the "other" area.
verbal corrections (e.g., "no", yelling, warning, etc)
physical correction (e.g., leash pops, squirting, other--please specify)
positive reinforcement (what do you use for the reinforcer?)
prong collar/tightening collars
shock collar/vibrating collars
Please elaborate with details on your choices above.
So far, how do you let your dog know what behavior you want and how have you addressed undesired behavior?
Have you taken the dog to any training previously? If so, when, for how long, and with whom?
Has your dog ever been confiscated or quarantined by animal control, or otherwise involved with animal control?
Please explain details.
Please describe the details of any behavior problems you or anyone else has experienced with the dog.
Use 'word pictures' to help us envision what happened.
Have any behaviors of concern started just recently? If no, when did they begin?
Has your dog ever bitten, tried to bite, lunged at, growled, or behaved aggressively toward any person or animal? If yes, please state which of these and why you think it happened.
Use 'word pictures' to help us envision what happened.
Please describe the events leading up to any bites, attempted bites, lunging, avoidance, or other behavioral concerns you have regarding the dog.
Again, use 'word pictures' to help us envision what happened.
Has the dog ever cowered, trembled, 'frozen,' attempted to avoid you or others, or seemed oddly uncomfortable? If yes, please state which of these
Please give details
Have there been any sudden or recent changes in the dog's life / environment?
How does your dog spend her/his days and evenings?
How many hours per day/night without you?
Where does s/he sleep (e.g., bedroom, couch, bed, crate, garage, kitchen, laundry room, yard, etc)
Is the dog ever crated, tethered, or otherwise confined? If so, for how long per day/night?
What does the dog most enjoy, and how often does the dog do that?
What do you most enjoy about the dog?
If you had to pick just one thing to change about your dog, what would it be?
If your dog had to pick one thing to change about you, what do you think it would be?
If you don't think s/he'd change anything about you, then what would s/he change about her/his lifestyle?
If you had to make up a creative name for your dog's personality type, what would it be & why?
If you had to make up a creative name for YOUR personality type, what would it be & why?
Yes, we know this is a bit silly. Humor us?
What issues, behaviors, &/or training would you like help with?
Basic Skills (e.g., Sit, Lie Down, Come, Walk on Leash, etc.)
Biting / Nipping / Mouthing
Drop it / Give
Jumping on people
Loose Leash Walking
Wait at Door until Released
All Behavior Modification Foundations
All Positive Reinforcement Foundations
Please give details on your selections above.
What type of training program do you think might best suit your and your dog's needs?
Work for Me (Train My Dog For Me)
Work with Me (Guide me in Training My Dog)
Zoom (live one on one video conferencing sessions)
What type of learner are you? Please choose the main one.
Visual (images, photos, graphs help more than words)
Auditory (Discussions, lectures, conversations help most)
Kinesthetic (Physical practice/experiences)
Reading/Writing (Writng notes, reading written words)
Which of these traits best describes you:
What do you feel is the FIRST/MOST IMPORTANT thing that you and your dog need help with?
What really matters to you about the dog training or behavior consulting process?
Why is it important to you to achieve the result you hope for?
Investment constraints: About what do you envision spending in time and money to achieve your goal?
As much time as it takes, flexible budget
As much time as it takes, between $300 and $500 total
Less than $3000 total over no more than six months
I only have a couple of weeks to reach my goal but I have no budget limit
I want to resolve the issue/reach my goal in no more than three sessions.
My budget is somewhere between $500 and $2000.
I would like to spend no more than a few months on this.
I do not envision practicing maintenance training once sessions are complete.
I do envision practicing maintenance training once sessions are complete.
Once my current goal is reached, I'd like to work on another.
What kind of work do you do? (occupation)
Where did you hear about Expert Canine?
Sorry to ask, but as someone with an autoimmune disorder, I must: When did you and your household members complete full COVID vaccinations? (If not complete, there may still be options available for EC services.)
Month, day, year.
Your Full Legal Name:
Your Signature (full legal name)
Sign with your fingertip or your mouse.
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